Tonsil surface and core cultures in recurrent tonsillitis: Prevalence of anaerobes and beta-lactamase producing organisms

  • I. J. Mitchelmore
  • P. G. Reilly
  • A. J. Hay
  • S. Tabaqchali


The bacterial flora of the tonsil surface and core was compared in patients suffering from recurrent tonsillitis. Surface swabs and tonsil core tissues were received as paired samples from 50 patients admitted for elective tonsillectomy. Analysis of paired samples from individual patients revealed differences in the bacterial flora of the tonsil core and the tonsil surface. Of 366 aerobic isolates, 30 % grew from the surface alone, 26 % from the core only and 44 % from both sites. Of 290 anaerobic isolates, 35 % grew from the surface alone, 33 % from the core only and 31 % from both sites. The total number of isolates from surface and core samples was similar (average 9.2 and 8.8, respectively). The range of species isolated was also similar for both surface and core samples, as was the proportion of organisms producing beta-lactamase from each site (10.7 % and 9.5 %, respectively). Eighty-two percent of patients carried beta-lactamase-producing organisms on either the tonsil surface or in the core tissue. A surface swab does not reliably reflect the types of organisms present in the tonsil core in individual patients. Anaerobes are a major component of tonsil surface and core bacterial flora in patients with recurrent tonsillitis. The high carriage rate of beta-lactamase-producing organisms in the tonsils should be considered when selecting antimicrobial therapy for persistent or recurrent tonsillitis.


Core Sample Paired Sample Antimicrobial Therapy Core Tissue Bacterial Flora 
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  1. 1.
    Palumbo FM: Pediatric considerations of infections and inflammations of Waldeyer's ring. Otolaryngologic Clinics of North America 1987, 20: 311–316.PubMedGoogle Scholar
  2. 2.
    Timon CI, Cafferkey MT, Walsh M: Fine-needle aspiration in recurrent tonsillitis. Archives of Otolaryngology, Head and Neck Surgery 1991, 117: 653–656.Google Scholar
  3. 3.
    Brook I, Yocum P, Shah K: Surface vs. core-tonsillar aerobic and anaerobic flora in recurrent tonsillitis. Journal of the American Medical Association 1980, 15: 1696–1698.Google Scholar
  4. 4.
    Almadori G, Bastianini L, Bistoni F, Paludetti G, Rosignoli M: Microbial flora of surface versus core tonsillar cultures in children. International Journal of Pediatric Otorhinolaryngology 1988, 15: 157–162.PubMedGoogle Scholar
  5. 5.
    Ross PW: Bacteriological monitoring in penicillin treatment of streptococcal sore throat. Journal of Hygiene 1971, 69: 355–360.PubMedGoogle Scholar
  6. 6.
    Tuner K, Nord CE: Beta-lactamase-producing anaerobic bacteria in recurrent tonsillitis. Journal of Antimicrobial Chemotherapy 1982, 10,Supplement A: 153–156.Google Scholar
  7. 7.
    Jokipii AMM, Jokipii L, Sipila P, Jokinen K: Semiquantitative culture results and pathogenic significance of obligate anaerobes in peritonsillar abscesses. Journal of Clinical Microbiology 1988, 26: 957–961.PubMedGoogle Scholar
  8. 8.
    Reilly S, Imms P, Beeden AG, Willis AT: Possible role of the anaerobes in tonsillitis. Journal of Clinical Pathology 1981, 34: 542–547.PubMedGoogle Scholar
  9. 9.
    Nord CE, Heimdahl A, Tuner K: Beta-lactamase producing anaerobic bacteria in the oropharynx and their clinical relevance. Scandinavian Journal of Infectious Diseases 1988, Supplement 57: 50–54.Google Scholar
  10. 10.
    Brook I, Yocum P: Quantitative measurement of beta-lactamase in tonsils of children with recurrent tonsillitis. Acta Oto-Laryngologica 1984, 98: 556–559.PubMedGoogle Scholar
  11. 11.
    Hibbert J: Acute infections of the pharynx and tonsils. In: Stell PM (ed): Scott-Brown's Otolaryngology. Volume 5, Laryngology. Butterworths, London, 1987, p. 76–98.Google Scholar
  12. 12.
    Barrow GI, Feltham RKA (ed): Cowan ST and Steele KJ. Manual for the identification of medical bacteria. Cambridge University Press, Cambridge, 1992, p. 50–164.Google Scholar
  13. 13.
    Sutter VL, Citron DM, Edelstein MAC, Finegold SM: Wadsworth anaerobic bacteriology manual. Star Publishing, Los Angeles, 1985.Google Scholar
  14. 14.
    Brook I, Foote PA: Comparison of the microbiology of recurrent tonsillitis between children and adults. Laryngoscope 1986, 96: 1385–1388.PubMedGoogle Scholar
  15. 15.
    Flodstrom A, Hallander HO: Microbial aspects on peritonsillar abscesses. Scandinavian Journal of Infectious Diseases 1976, 8: 157–160.PubMedGoogle Scholar
  16. 16.
    Mulligan ME: Ear, nose, throat and head and neck infections: oropharyngeal infections. In: Finegold SM, George WL (ed): Anaerobic infections in humans. Academic Press, San Diego, 1989, p. 274–276.Google Scholar
  17. 17.
    Lewis MAO, MacFarlane TW, McGowan DA: Quantitative bacteriology of acute dento-alveolar abscesses. Journal of Medical Microbiology 1986, 21: 101–104.PubMedGoogle Scholar
  18. 18.
    Brook I, Friedman EM, Rodriguez WJ, Controni G: Complications of sinusitis in children. Pediatrics 1980, 66: 568–572.PubMedGoogle Scholar
  19. 19.
    Kambal AM: Isolation ofStreptococcus milleri from clinical specimens. Journal of Infection 1987, 14: 217–223.PubMedGoogle Scholar
  20. 20.
    Tuner K, Nord CE: Emergence of beta-lactamase-producing organisms in the tonsils during penicillin treatment. European Journal of Clinical Microbiology 1986, 5: 399–404.PubMedGoogle Scholar
  21. 21.
    Simon HM, Sakai W: Staphylococcal antagonism to penicillin-G therapy of hemolytic streptococcal pharyngeal infection: effect of oxacillin. Pediatrics 1963, 31: 463–469.PubMedGoogle Scholar
  22. 22.
    Brook I, Yocum P: In vitro protection of group A beta-hemolytic streptococci from penicillin and cephalothin byBacteroides fragilis. Chemotherapy 1983, 29: 18–23.PubMedGoogle Scholar
  23. 23.
    Hackman AS, Wilkins TD: In vivo protection ofFusobacterium necrophorum from penicillin byBacteroides fragilis. Antimicrobial Agents and Chemotherapy 1975, 7: 698–703.PubMedGoogle Scholar
  24. 24.
    Brook I, Pazzaglia G, Coolbaugh JC, Walker RI: In vivo protection of group A beta-hemolytic streptococci by beta-lactamase producingBacteroides species. Journal of Antimicrobial Chemotherapy 1983, 12: 599–606.PubMedGoogle Scholar
  25. 25.
    Brook I, Gober AE: Emergence of beta-lactamase-producing aerobic and anaerobic bacteria in the oropharynx of children following penicillin chemotherapy. Clinical Pediatrics 1984, 23: 338–341.PubMedGoogle Scholar
  26. 26.
    Brook I: Emergence and persistence of beta-lactamase-producing bacteria in the oropharynx following penicillin treatment. Archives of Otolaryngology 1988, 114: 667–670.Google Scholar
  27. 27.
    Brook I: Role of beta-lactamase-producing bacteria in penicillin failure to eradicate group A streptococci. Pediatric Infectious Disease Journal 1985, 4: 491–495.Google Scholar
  28. 28.
    Brook I, Leyva F: The treatment of the carrier state of group A beta-hemolytic streptococci with clindamycin. Chemotherapy 1981, 27: 360–367.PubMedGoogle Scholar
  29. 29.
    Brook I, Hirokawa R: Treatment of patients with a history of recurrent tonsillitis due to group A beta-hemolytic streptococci. Clinical Pediatrics 1985, 24: 331–336.PubMedGoogle Scholar
  30. 30.
    Brook I: The role of beta-lactamase-producing bacteria in respiratory tract infections. Scandinavian Journal of Infectious Diseases 1988, Supplement 57: 41–49.Google Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1994

Authors and Affiliations

  • I. J. Mitchelmore
    • 1
  • P. G. Reilly
    • 2
  • A. J. Hay
    • 1
  • S. Tabaqchali
    • 1
  1. 1.Department of Medical MicrobiologySt. Bartholomew's Hospital, West SmithfieldLondonUK
  2. 2.Ear, Nose and Throat DepartmentSt. Bartholomew's Hospital, West SmithfieldLondonUK

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